As you may be aware, a trend towards free-standing ERs are popping up in areas around your city. Beware of the differences between a free-standing ER and an Urgent Care clinic. At first glance, free-standing ERs look like an Urgent Care Clinic but there’s a BIG difference. While an urgent care clinic’s billing is usually similar to that at your doctor’s office, billing at a free-standing ER is like a trip to a hospital ER.
What impact does this have on you as a patient? As a patient, you will have significant out-of-pocket costs. Your insurance company may not contract with free-standing ERs, therefore, leaving you with a large out of pocket bill. The out of pocket bill will have exceeded the cost of care at your primary care physician (PCP) or an urgent care clinic. You will be responsible for this large out of pocket bill, and you will be balance billed by the free-standing ER causing you financial ramifications.
UNDERSTANDING THE DIFFERENCE CAN SAVE YOU MONEY
Urgent Care Centers and Free Standing ERs can be hard to tell apart. Free Standing ERs often look a lot like Urgent Care Centers, but costs are higher, just as if you went to the ER at a hospital.
True Patient Story
Frisco resident Pam Lee mistakenly visited an FSEC during Thanksgiving weekend. She had a cough, sniffles, and chest congestion. “ I just said, ‘I’m going to drive to a doc in the box,’” Lee told NBC 5. She said she went to an Emergency Center in Frisco, only a few blocks from her home. But weeks later, a trip to the mailbox really made her sick when she saw her bill. “I can’t believe they would charge that for a cold,” Lee complained. Her bill from the physician was just over $73. But the facility fee was $980. So the total cost for her cold was $1,053.11. “I just don’t have a thousand dollars to spend on a cold,” said Lee. When she called about the bill she was told she’d been to a free-standing emergency room — not an urgent care clinic. “I didn’t know there was a difference,” Lee said. “I thought any little stand-alone clinic like that was a doctor’s office,” said Lee. But there’s
a big difference. Lee signed a form acknowledging that this “emergency facility” would bill her insurance provider “under her emergency department benefits.” It’s a lesson
Lee said she won’t soon forget.
HOW DO YOU TELL THE DIFFERENCE?
Here are some ways to know if you are at a Free-Standing ER:
- Are open 24 hours a day, seven days a week
- Are physically separate from a hospital
- Are subject to the same copay as hospital ER
- Are staffed by ER physicians
If you’re sick or injured, you need to know where to go for medical help. If you can’t get in to see your primary care provider (PCP) how do you decide between an urgent care clinic or the emergency room? Knowing the difference between the two will give you a clearer idea of what choice you should make.
| Urgent Care Clinics | Hospital ER | Free-Standing ER |
| Offers quality care on a walk-in basis | Good care, but may have a long wait time (several hours) | Good care, but may have a long wait time (several hours) |
| Provides complex services such as x-rays, laboratory work and pharmacy | Specially trained doctors make recommendations on a wide variety of medical issues | Specially trained doctors make recommendations on a wide variety of medical issues |
| Focuses on diagnosing and treating conditions that are not life-threatening yet need immediate care | Treats severe and life-threatening conditions | Treats severe and life-threatening conditions |
| Have extended evening and weekend hours | Open 24 hours a day, seven days a week | Open 24 hours a day, seven days a week |
| Lowest Cost | High Cost | Higher Cost |
WHEN TO VISIT WHERE
Urgent Care
|
Emergency Room
|
Please note: The above list is not a full list of symptoms and serves only as an example.
Hospital emergency rooms are designed to focus on true catastrophic medical emergencies. They are not intended to focus on urgent care needs.
Keep in mind that the cost of going to a walk-in clinic is significantly lower than the cost of visiting the ER, so if your situation is not an acute life-threatening illness or injury you should go to the walk-in clinic instead. When in doubt, ask the front desk if they bill as an ER.
Contact your Care Coordinator with any questions about your coverage or for assistance locating a doctor or facility at 888.803.0081.